SEX AND THE CSA!

Why Do We Fear Asking Questions About Sex and Sexuality in CSA?

Yes, I felt veryyyy embarrassed when taking sexual history when I was a junior doctor.

I feel better now (still not perfect) after observing my Trainers and Nurses when I did my DFSRH in the dedicated Sexual Health Clinics.

httpv://youtu.be/z5aE-mokCQs

It might be difficult in CSA if you are not prepared your laser targeted questions well ahead.

I think we should not see sexual matters as being purely the realm of GUM clinicians.

Taking a sexual history and doing a STI risk assessment are the cornerstone of good sexual health practice.

In female patients, taking a sexual history could also prompt discussions about the patient’s risk of unplanned pregnancy and the need for contraception, including the provision of emergency contraception.

In CSA, we can have scenarios like a young female with pelvic pain or a young man with fever, pharyngitis and rash…

We might easily miss the agenda of addressing STI risk if we do not get good sexual history…

And FAIL CSA 🙁

They might have told you that she had unprotected intercourse with four partners in the last six months and the man had unprotected, receptive, and insertive anal sex with five casual male partners in the last three months.

We can see to what extent the knowledge of these patients’sexual risk behaviour influence our differential diagnosis!

YES…

The Sexual History Influences Management in CSA!!!

Let’s Talk About SEX !

Are you Ready?

General Tips

Ensure Privacy and Confidentiality.

Be Professional and Open minded.

Adopting a Non-judgemental, Frank Approach is the key.

Put the Patient at Absolute Ease.

An Embarrassed Doctor begets an Embarrassed Patient.

Be Aware of your Own Body Language and Gesturing.

Adopt an Open Posture.

Echo their Body Language, Maintain Eye Contact.

Explain Why Asking Sexual History is Relevant.

Keep your Questions Focused and Relevant.

Pick up on Subtle Non-verbal Cues from the Patient.

Promote Risk Reduction and Good Sexual Health.

VERY VERY IMPORTANT POINTS FOR CSA!

Consider Child Protection Issues!

This is an absolute requirement when discussing sexual activity (consensual or otherwise) in <13.

Set the Agenda and Obtain Consent.
Inform them that you are about to ask personal, and sometimes embarrassing, questions.

It is useful to pre-empt patients’ discomfort.

Use simple statements like –

“I would like to ask you some personal questions about your sex life. Would that be okay?”

Define what you (and the patient) mean by “sex”.

Never assume anything about their sex lives.

Use language that is easily understandable.

Patients may use language we are not familiar with.

Ask them what they mean.

Example Structured Approach

Feel free to change the words You are comfortable with.

(1) When did you Last have sex/sexual intercourse?

(2) Was it with a Man or a Woman?

(3) Was the person a Casual or Regular partner?

(4) Where was the partner from and what is their Ethnicity?

(5) In which Country did you have sex?

(6) What kind of sex did you have?

(7) For each type – oral, vaginal, anal—did you use a condom?

(For heterosexual sex: was any contraception used?
Relate to risk of pregnancy when asking about last menstrual period in gynaecology history.
Assess whether they were the active/insertive partner or passive/receptive partner, as appropriate.

(8) Does/did your partner have any symptoms?

(9) When did you last have sex with someone different? Return to question 2.

Repeat this for all sexual contacts in at least the preceding 12 weeks.

My Tip 🙂 – Never, Never assume the sex of previous partners.

For men who report recent sexual activity with women –

It might be useful to ask if they have ever had sex with men in the past.
(10) Have you ever had any previous STIs?

(11) Have you ever had a sexual health check up before?

(12) Have you, or have any of your sexual partners, ever injected drugs or shared injecting drug equipment?
For women, have you ever had sex with a gay or bisexual man?

For Men,
Ask about any history of sex with men, as per point (9).

(13) Have you ever had an HIV, hepatitis, syphilis test before?
(Assess risk and offer tests as appropriate)

(14) Have you been vaccinated against hepatitis B, or have you ever had hepatitis?
(Assess risk and offer vaccination if appropriate).

The most important thing is To show Empathy throughout your Consultation…

Go with the flow…

Never attempt to cover all and drift towards doctor centredness… which will be very lethal…

Be Cautious when dealing with the Highly Emotional Packed Scenarios like Rape, Assault, etc…

Take your Time… Be Patient centered all the time!

Here is an example video – Taking a Sexual History

Sexual activity is a health behaviour and therefore it is important that doctors are able to gather information about sex confidently and competently. In this consultation, the patient presents to his GP with a worry that he may have contracted a sexually transmitted disease. It is important for the GP to enquire about the patient’s risk factors in a sensitive and non-judgmental way. The GP needs to gather information about the patient’s sexual activity and work with the patient to negotiate a plan.

httpv://youtu.be/V5ouk1SJbOs

Thatsss Alllll…Great!

Hakunaaa… Matataaa!
(Now, Watch Lion King To Find the Meaning!)

Sexual History is a Powerful Diagnostic and Therapeutic Tool!

Feel Comfortable Tackling Sexual Health Issues.

Make Efforts to Improve the Sexual Health of our Patients.
Consistent Practice makes it Perfect!